Second hepatoma developing 13 years after resection of first tumor.

A patient underwent a left-sided hepatic lobectomy for primary hepatocellular carcinoma 13 years ago and remained symptom free. He then presented with spontaneous rupture of a large tumor in the right lobe of the liver. Although this tumor proved to be primary hepatocellular carcinoma, there were significant histological differences between the two lesions, suggesting that this was a second primary liver tumor. Bleeding from the tumor was controlled by selectively ligating the branches supplying the area of hemorrhage.

Pancreatic fibrosis in chronic alcoholics and nonalcoholics without clinical pancreatitis.

A postmortem study was undertaken to determine the prevalence and nature of pancreatic injury in chronic alcoholics with no clinical pancreatitis. The material for this postmortem study was obtained from 101 entire pancreata. From five sites in each of the pancreata, sections were obtained and evaluated by two pathologists who used a 0-3 numerical grading of fibrosis. Forty-seven percent of the alcoholics had diffuse fibrosis of all five segments, in contrast to only 29% of the nonalcoholics. No fibrosis was present in 32% of the alcoholics and 56% of the nonalcoholics (p less than 0.05). The nonalcoholics tended to show an increase with age in the proportion of cases having fibrosis. The data suggest that there is ongoing pancreatic damage in chronic alcoholics before the onset of clinical pancreatitis.

A histiocytic medullary reticulosis-like syndrome as the terminal event in lymphocytic lymphoma.

Histiocytic medullary reticulosis is a rare disease of the reticuloendothelial system. The diagnosis of this disorder has generally been established by postmortem examination following a rapidly fatal clinical course characterized by fever and pancytopenia. Originally described as a de novo disease of unknown etiology, a histiocytic medullary reticulosis-like syndrome has been more recently found in association with a number of other disorders, the majority being lymphoreticular neoplasms. This report describes a patient with a 9-year history of lymphocytic lymphoma which terminated in a rapidly fatal disease which, clinically and pathologically, was consistent with a diagnosis of histiocytic medullary reticulosis.

Nutrition in the pathogenesis of alcoholic pancreatitis.

The pathogenesis of chronic alcoholic pancreatitis is unclear. Some European studies have shown that alcoholics who develop pancreatitis consume a diet richer in protein and fat than normal controls. The infrequency of alcoholic cirrhosis in patients with alcoholic pancreatitis in these studies was explained by this enhanced nutritional intake protecting the liver but not the pancreas. In this study we evaluated by an oral recall method the nutritional intake of patients with alcoholic pancreatitis or alcoholic cirrhosis prior to the onset of symptomatology and compared the data with established norms. Our data did not confirm the European observation that pancreatitis patients consume amounts of protein and fat, more than the general population and more than alcoholics with cirrhosis. Furthermore, the combined incidence of cirrhosis and pancreatitis was not infrequent. Our observations do not disprove that a high fat and/or protein diet predispose to pancreatitis but suggest that such a diet is not a prerequisite for alcoholics to develop pancreatitis.

Arterial encasement in xanthogranulomatous pyelonephritis.

A case of xanthogranulomatous pyelonephritis is reported in which arterial encasement was demonstrated. Pathologic correlation is shown.